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Trauma, Loss,

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London: Jessica Kingsley Publishers. Some background as to the impact of ... time, i.e., while watching TV, bored in class, before falling asleep; playing ... – PowerPoint PPT presentation

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Title: Trauma, Loss,


1
Trauma, Loss, Grief in Children
  • Terr, L.C. (1991) Childhood Traumas An Outline
    Overview. American Journal of Psychiatry,
    14810-20
  • Dyregrov, A. (1992) Grief in Children. London
    Jessica Kingsley Publishers

2
Some background as to the impact of Childhood
Traumas
  • Studies have shown a correlation between abuse or
    shock in childhood to (1) adults in mental
    hospitals (2) adults suffering from multiple
    personalities (3) borderline adults and (4)
    adults who go on to commit murder
  • Those who harm children have often been harmed
    themselves as children
  • Childhood psychic trauma leads to a number of
    mental changes that go on to account for some
    adult character problems, i.e., anxiety
    disturbances, extremes of passivity, considerable
    violence, certain types of psychotic thinking,
    and dissociation

3
2 Types of Childhood Traumas
  • Type I the single, sudden unexpected event
  • Type II the longstanding or repeated ordeals

4
Characteristics Common to most cases of Childhood
Trauma
  • Visualized or repeatedly perceived memories
    ability to re-see event(s) children tend to see
    old traumas at leisure time, i.e., while watching
    TV, bored in class, before falling asleep
    playing out or drawing their trauma
  • Repetitive behaviors behaviors physical
    responses that re-enact the event, repeating
    aspects of the terrible event

5
Childhood Trauma Characteristics (cont.)
  • Trauma-specific fears fears of specific things
    that are related to experiences precipitated by
    trauma children fear and recreate what they
    originally experienced
  • Changed attitudes about people, life, and the
    future sense of a severely limited future
    reflects ongoing belief that more traumas are
    bound to happen mistrust towards a particular
    gender or adults

6
Type I Feature Characteristics (most typical PTSD
in childhood)
  • Full, detailed memories able to remember the
    event give clear, detailed accounts of
    experiences. Children traumatized by a single
    event do not forget
  • Omens reworking rethinking of event to
    explain why it happened to them preoccupied with
    how will I avoid it next time?
  • Misperceptions misidentifications, visual
    hallucination time distortions

7
Type II Feature Characteristics
  • The first event creates surprise, but the
    subsequent events create a sense of anticipation,
    so that the psyche attempts to preserve the self
  • Defense mechanisms / coping include massive
    denial, repression, dissociation,
    self-anesthesia, self-hypnosis, identification
    with the aggressor, and aggression turned into
    self

8
Crossover Type I / Type II Trauma
  • Ongoing stresses tend to push changes in the
    child towards characteristics of Type II traumas
  • ex death of a parent, homelessness, handicap or
    disfigurement, event causes prolonged
    hospitalization or pain
  • Psychic shock interferes with childhood
    bereavement and vice versa

9
Emotions Associated with Childhood Psychic Trauma
  • Terror
  • Rage
  • Denial and Numbing
  • Unresolved Grief
  • Shame and Guilt

10
Terror (fear of fear)
  • young children tend to go on behaving almost as
    usual
  • an immobility of expression failure of the
    mouth to move, lack of animation in the eyes,
    look dazed
  • Internally feels the awareness of helplessness,
    fearing another event, fear the separation from
    loved ones, and fear death
  • They may look relatively natural on the inside,
    but on the inside, are just falling apart
  • Traumatic fright is unique and it is remembered.

11
Rage
  • Anger in place of trust
  • Wild fluctuations between active anger and
    extreme passivity
  • Aggression towards others or anger turned inward
  • Anger becomes integrated into the personality

12
Denial and Numbing
  • Accommodation to extreme, longstanding trauma
    (sexual physical abuse)
  • Often forget, sometimes segments of their
    childhood
  • Indifference to pain
  • Lack of empathy
  • Inability or failure to acknowledge feelings
  • Avoidance of psychological intimacy

13
Unresolved Grief
  • The grief process tends to be more prolonged with
    children because of developmental issues
  • Can get stuck in any one stage of the grieving
    process
  • Their immature cognitive understanding may
    promote denial of the reality

14
Shame and Guilt
  • Shame is the childs sense of humiliation in
    being victimized comes from public exposure of
    ones vulnerability
  • Guilt is the childs sense of failure to
    measure up to private, internal standards you
    feel you caused you own problems
  • Consciously suppressing any talk and even any
    thinking about the traumatic event(s)
  • The combination of shame and suppression may
    force traumatized children to lie

15
How do we conceptualize the intersection of
Separation, Loss and Grief?
16
  • Change that occurs when there is a breakup in a
    relationship

SEPARATION
17
  • Effect on people when something important is
    withdrawn

LOSS
18
  • Process that helps people work through the pain
    of separation and loss

GRIEF
19
Infancy
  • Effect of separation
  • - React to noise, visual
  • - May become less felxible
  • What helps
  • Keep changes to a minimum
  • Rebuild trust in adults

20
Toddlers
  • Effect of separation
  • - Damages sense of independence self-esteem
  • - May regress
  • - spark memories in future
  • What helps
  • - Develop balance between independence
    dependence
  • - Tolerate clingy behavior

21
6-10 Year Olds
  • Effect of separation
  • - age of assertion anger
  • - need to reason out loss
  • - mixed feelings
  • - interferes with ability to develop friendship
  • What helps
  • - need nurturing
  • - help with peer relationships
  • - managing angry feelings

22
Adolescents
  • Effect of separation
  • - Taps into emotional instability
  • - Complicates issues of self-esteem and
    identity
  • - Confuse the anger
  • What helps
  • - Need to be full participants in the helping
    process
  • - help acknowledge sad angry feelings
  • - Need support

23
Types of Expected Losses for Children?
  • The loss is shared by all
  • Lots of support
  • Considered normal
  • No blame / shame
  • Prepared by life

24
Types of Unexpected Losses for Children?
  • The loss is not shared
  • It is not always normal
  • Sense of blame
  • Ill prepared
  • Support may be varied

25
Categories of Loss
  • Health physical or mental
  • Loved one through death or leaving
  • Self-esteem feelings of shame or blame
  • What other types of losses would you add to this
    list?

26
Grief from a Childs Developmental Perspective
  • Childrens understanding of death develops in
    parallel with the childs cognitive maturing
    through childhood
  • The development of the concept of death may occur
    at slightly different rates, but the
    developmental sequence seems to be the same

27
Below age 5
  • Do not understand that death is final
  • Death is reversible and unable to grasp that all
    functions of life have ceased
  • May be concerned about the physical well-being of
    the dead person
  • Does not understand that death is universal

28
Ages 5 to 10 Year Olds
  • Still concrete in their thinking
  • Magical components still part of their thinking,
    i.e., assume the dead person can see or hear the
    living and they may work hard to please the
    deceased
  • Begin to get a better grip on and understanding
    of death as unavoidable and universal
  • Feel compassion towards friends that lose parents
    or siblings

29
Ages 10 through Adolescence
  • Concept of death becomes more abstract
  • Able to understand the long-term consequences of
    a loss
  • Understand that death is universal and inevitable
    and that it can happen to me
  • Loss can bring about strong reactions

30
The Grief Process in Children
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance

31
Denial
  • In a state of disbelief and shock
  • Withdrawal and numbness
  • Increased anxiety, depression
  • Insomnia, nightmares
  • Ask to go home
  • Turn to fantasy world
  • Physical ailments
  • Stress reactions, i.e., biting nails pulling hair

32
Anger
  • Realize loss has occurred and cannot be undone
  • Express anger directly and verbally
  • Express anger at self or others
  • Hurtful to self or others

33
Bargaining
  • Feel that by making a deal can make the situation
    go away
  • Yearning and wishing for a different ending
  • Identification with characters that suffer loss
    and reunite (Cinderella, Snow White, etc.)
  • Blame self / others
  • Regression is normal

34
Depression
  • Feelings of hopelessness, sadness anger turned
    inward
  • Excessive fear
  • Lack of interest
  • Clingy behaviors
  • Suicidal gestures
  • Poor school performance
  • Sexual promiscuity

35
Acceptance
  • Process of letting go
  • Express positive and negative feelings about the
    loss
  • Express more hope
  • Learn to cope with painful feelings

36
What can make grief worse?
  • Adults handling of the death or situation
  • Type of loss
  • Relationship with the dead person
  • Support
  • Access to a replacement person
  • Fantasies and causal thinking
  • Personality and former experience
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